Danger of Delay Tactics With Breast Cancer

In 2000, Bonnie Grant, now executive director of the Greater Philadelphia Life Sciences Congress at the Philadelphia Convention & Visitors Bureau, and a board member of the Foundation for Breast and Prostate Health, was working for the Office of the City Representative in Philadelphia.

With the Republican National Convention due to take place in Philadelphia that year, her job required a great deal of time and energy.

It was not a good time to discover a suspicious lump on her breast.

On such occasions, the first impulse is denial. But Grant was tuned in to her body. Had she not been, she might not have discovered the lump. She conceded, however, "I waited much longer than I should have to get it checked out. I'd never advise anyone to do that."

Grant did what many have done under the circumstances: put further investigation on the back burner. But the tumor "grew very fast," and a mammogram showed a "very likely malignancy," she said.

Fortunately, when the reality hit home, she did take action and had a needle biopsy at the recommendation of her gynecologist. Even so, she was not about to miss out on a much-anticipated acting workshop in New York.

While there, however, she was confronted with the news that she needed immediate treatment.

Her cancer had progressed to Stage 3b, which, according to the National Cancer Institute website, indicates spreading to a wide area, "to lymph nodes near the breastbone."

As difficult as this news was to absorb, Grant remembers being grateful for the many resources Philadelphia offers -- its teaching hospitals, leading researchers and state-of-the-art treatments.

In particular. she credits Dr. Gordon Schwartz, secretary of the Foundation for Breast and Prostate Health, who advised her on her options, recommending the Fox Chase Cancer Center, one of the nation's leading medical facilities.

Treatment began with pre-op chemotherapy for three months. She was told that the tumor had become too large to be safely removed by surgery; thus, chemotherapy was needed to shrink it.

Following this round of chemo, she had a mastectomy with tram flap reconstruction -- a procedure immediately following a mastectomy in which the surgeon transfers skin, fat and muscle from the abdomen to reconstruct the breast. She underwent another six months of chemotherapy, and has been on Tamoxifen, an estrogen blocker commonly used in treating breast cancer, for five years.

All this may seem routine; when the treatment succeeds, there is the temptation to think that the disease has been conquered, that even as breast cancer interrupts life, it is inevitably defeated.

Yes -- and no. Certainly, treatment protocols have progressed considerably, and the awareness of breast cancer has grown as well.

However, a great deal can go wrong, as Grant reports. During chemo, she was kept in isolation, because her immune system, weakened from the treatment, made her more vulnerable to infection. And although reconstructive surgery may allow women with breast cancer to return to a normal appearance, it is not for everyone.

Grant had been told that women who become very frail or thin from their treatments are not good candidates for reconstructive surgery. She counts herself fortunate to have been able to have the procedure.

But, after the surgery, Grant learned, she still had cancer and needed more chemotherapy.

The time in isolation was particularly discouraging, she said. But through family, she found the strength to fight cancer: "I had two teenage sons" at the time and was motivated to carry on.

As Grant noted, breast cancer "can happen to anyone," but it doesn't need to spell doom, even at the late stage at which her cancer was diagnosed.

Certainly, Grant's story represents the progress made in breast cancer treatment and awareness of the disease.

But it was not always so. In 1990, reports Shelley Schwartz, wife of Dr. Gordon Schwartz, her husband came home one day and said to her, "We have an epidemic of breast cancer and no one is talking about it." Her husband, Schwartz said, thought it was necessary to raise awareness and funds.

Thus was born the Breast Health Institute. Initially, the fundraising efforts by Shelley Schwartz and others were directed toward securing mammograms for uninsured women in Philadelphia; later other procedures benefitted.

"We were very hands-on with hospitals," Shelley Schwartz said, which then helped patients get into the social service system for further treatment.

In particular, Schwartz expressed satisfaction with helping start the conversation on the disease. A landmark achievement, she noted, were the "consensus conferences."

According to Schwartz, the institute "developed a think tank of leading physicians in Europe and America to help us decide where they'd like to see funds spent."

These doctors were asked to focus on a controversial topic that needed answers. The "most important names in breast disease," she said, came together to develop a response, which was then published concurrently in several leading journals.

A process that began with calling upon a "group of friends" for help in fundraising has expanded to a worldwide organization that later became Breast Health International.

In 2004, Breast Health International and Prostate Health International combined to form the Foundation for Breast and Prostate Health. But while much has been done, said Schwartz, there is still much to do. She pointed out that the link-up with Prostate International brought together work on two hormone-based diseases, but that prostate awareness is where breast cancer awareness was 20 years ago.

With October deemed Breast Cancer Awareness Month, she noted that men can also get breast cancer. Often because they don't think it's a men's disease, they may delay treatment.

For women, Schwartz emphasized the need for regular self-examination and mammograms. Taking the time to attend to early signs of breast cancer, she said, can save time and life itself.